Provider Demographics
NPI:1588111884
Name:RESH, JENNIFER (CRNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:RESH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3233 CHESTNUT RIDGE RD # B
Mailing Address - Street 2:
Mailing Address - City:GRANTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21536-1370
Mailing Address - Country:US
Mailing Address - Phone:301-697-3334
Mailing Address - Fax:
Practice Address - Street 1:3233 CHESTNUT RIDGE RD # B
Practice Address - Street 2:
Practice Address - City:GRANTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21536-1370
Practice Address - Country:US
Practice Address - Phone:301-697-3334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-02
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV83466363LF0000X
MDR177351363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily